Major problems in cancer control are related, in part, to perceptions about cancer risk. These cancer control problems include smoking among African Americans and lack of adherence to mammography. In addition, risk perceptions affect women's decisions about whether to get mammograms and take estrogen replacement therapy (ERT). We propose to focus an outstanding group of Duke University investigators and a larger group of superb consultants on the vital topic of cancer risk communication. Never before has there been a concerted, comprehensive approach to cancer risk communication. Our goals are to develop a theoretical understanding of how people process risk information, develop and test population- sensitive measures of risk perception, develop useful techniques to improve risk comprehension and develop effective and cost-effective interventions to improve both decision making and cancer-related behaviors. As a result, we hypothesize that smoking will be reduced among African Americans and mammography use increased among women in their 50's and 60's. Moreover, we will improve decision making for mammography and ERT use. This CPRU includes three projects (one in which we will use biomarkers of genetic susceptibility to facilitate smoking cessation among African Americans, a study to facilitate informed decision making about ERT and a similar project on mammography), one developmental project (to develop an improved model of breast cancer risk prediction) and four cores (administration, biostatistics, cost-effectiveness and a risk laboratory), all developed with intentional synergy. All intervention projects include tailored print interventions and two will test the additional impact of telephone counseling, as well. All intervention-related data will be collected through telephone interviews. The use of core variables will permit comparisons across topics and populations. There will be sufficient African Americans and women to examine the effect of race and gender in these studies. We believe that this focused effort could lead to major advances in cancer control by developing the next generation of state-of-the-science interventions which will be grounded firmly in an understanding of cancer risk communication.